The Effect of Diuretics on Mineral and Bone Disorder in Chronic Kidney Disease Patients
Status:
Unknown status
Trial end date:
2018-06-01
Target enrollment:
Participant gender:
Summary
Chronic kidney disease (CKD) patients often have associated systemic hypertension due to
volume retention, as one of the mechanisms, therefore the use of diuretics is widespread in
this population. One of the major complications of CKD is mineral and bone metabolism
disorder (CKD-MBD), which include changes in the levels of calcium, phosphorus, vitamin D
deficiency, increased circulating levels of fibroblast growth factor (FGF-23) and parathyroid
hormone (PTH). These alterations are responsible for fractures, cardiovascular disease and
mortality among patients with CKD. According to diuretic mechanism of action, sometimes
increasing serum calcium (in the case of furosemide), sometimes decreasing it (in the case of
thiazide), it is expected that the serum calcium may be altered, even within the range of
normality, with consequent impact on the levels of PTH. Although most studies have shown that
the use of thiazide diuretics decreases the risk of fractures, some showed the opposite.
Similarly, although most studies have shown increased risk of fracture in association to loop
diuretics use, some have failed in demonstrated this outcome. Only one study, a cohort study
in a population of CKD, showed that furosemide was directly related to increased calciuria
and PTH levels and the use of thiazide, in turn, showed completely opposite effect. However,
certain issues are still not completely solved, for example, the interference of renal
function itself on calciuria. It is possible that calciuria is not a so simple explanation
that justifies the PTH levels changes, as no correlation was seen between calciuria and PTH
levels. Better understanding of the exact relationship between the use of diuretics and the
impact on CKD-MBD may be an alternative intervention, easily accessible and relatively
inexpensive. The purpose of this study is to evaluate the impact of diuretic, specifically
hydrochlorothiazide and furosemide, on bone architecture and mineral metabolism.